Provider Demographics
NPI:1669927893
Name:KORALLUS, MARIE ANN (RN, MSN, APRN,FNP-C)
Entity type:Individual
Prefix:MRS
First Name:MARIE ANN
Middle Name:
Last Name:KORALLUS
Suffix:
Gender:F
Credentials:RN, MSN, APRN,FNP-C
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:ANN
Other - Last Name:KORALLUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APN
Mailing Address - Street 1:6170 JOLIET RD STE 1
Mailing Address - Street 2:
Mailing Address - City:COUNTRYSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-3971
Mailing Address - Country:US
Mailing Address - Phone:708-352-0330
Mailing Address - Fax:708-352-8905
Practice Address - Street 1:6170 JOLIET RD STE 1
Practice Address - Street 2:
Practice Address - City:COUNTRYSIDE
Practice Address - State:IL
Practice Address - Zip Code:60525-3971
Practice Address - Country:US
Practice Address - Phone:708-352-0330
Practice Address - Fax:708-352-8905
Is Sole Proprietor?:No
Enumeration Date:2016-08-17
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.018644363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily